In response to:
"Personally , I use l-epinephrine for bronchiolitis and it does seem to
but remember that a single dose of racemic epinephrine ( 0.5ml) is
equivalent to 11.25 mg of l-epinephrine or 11 ml's of 1:1000 epi"
This is not entirely true. Actually the math goes something like this.
Racemic Epi= 2.25%=2.25mg/cc
About 50% of racemic epi is the active form- L Epi. Therefore 11.25mg/cc
(to be more exact the other isomer is about 30% as active as L-form)
If you use standard racemic epi dose of 0.05cc/kg/dose to max of 0.5cc you
are actually giving 0.5625mg/kg/dose up to 5.625mg of L-Epi.
Therefore a 10kg child would get 0.5cc of racemic epi= 5.625mg of L-Epi
This is important only in rationalizing dose of L-Epi to give or tell the
ambulance to give if they are bringing in a critically croupy child.
You can tell them the dose of 1:1000 EPI is 0.5cc/kg/dose up to 5cc=5mg of
It also helps to answer the common question, "Why not use 1:10,000 Epi?"
The answer is it would take a large volume nebulizer and 50cc to equal the
standard dose of racemic in a 1 year old.
BTW I have used epi with good success in severe RSV cases but do not
personally believe it is usually necessary. Albuterol helps maybe 1/3 of
the time in my experience and Epi helps to some degree in most cases. I
believe, it is likely due to the alpha effects on mucosal thickening when
Epi is used over albuterol but don't recall any proof of this off hand.
Hope this helps,
Randy Cordle MD
Emergency Medicine of Idaho
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